TY - JOUR T1 - Revalidation: a critical perspective JF - British Journal of General Practice JO - Br J Gen Pract SP - 166 LP - 168 DO - 10.3399/bjgp11X561113 VL - 61 IS - 584 AU - Trisha Greenhalgh AU - Geoff Wong Y1 - 2011/03/01 UR - http://bjgp.org/content/61/584/166.abstract N2 - As the stadium for the 2012 Olympics rises brick by shining brick against the London skyline, the apparatus for revalidation of doctors in the UK is currently being constructed to a similar timetable (although tellingly, no date has been set for its opening ceremony).1 Revalidation's goals appear to be threefold: restore public trust in the medical profession; support professional development in all doctors; and weed out the bad apples.2–4 Many have pointed out that these goals may conflict (for example, professional development is a formative and supportive process, while dealing with unacceptably poor practice must surely be summative and judgemental) and that the evidence base linking the proposed input (5-yearly assessment of a portfolio) with the desired outcome (better, safer care for patients) is all but absent.5–8The research literature on revalidation is indeed sparse. For example, a single randomised trial in 66 Scottish GPs compared a light-touch, ‘criterion-based’ model with a more comprehensive, ‘educational outcome’ model; there were no differences in what was recorded in the portfolios or in self-reported changes in practice, but participants preferred the former model.9 In this study of volunteers, 20% of doctors did not hand in their portfolio and impact on patient care was not measured. Professional certification status in the US has been depicted as having led to improvements in quality of care, but online responses pointed out that association in an uncontrolled study does not prove causation.10We could find only one paper which applied an explicit theoretical model of professional practice to revalidation: 6 years ago, Paul Thomas argued in this Journal that:‘Shipman could have passed tests for medical competence. It was someone unafraid to ask ‘why do so many of your patients die?’ that found him out … Revalidation must … ER -